Barriers and facilitators of healthcare professionals in integrating shared decision-making in pancreatic cancer treatment: A network approach

Abstract

Purpose: Shared decision-making (SDM) is crucial in pancreatic cancer treatment due to its choice-sensitive nature and limited prognosis. Treatment of pancreatic cancer is organized in a network approach. Several obstacles exist on different levels-patient, healthcare professional, organizational, societal-that impede integration of SDM. This study aims to identify barriers and facilitators to SDM implementation within a comprehensive cancer network.

Methods: A qualitative research design was applied, involving interviews and focus groups on barriers and facilitators with healthcare professionals involved in the implementation of SDM. In one comprehensive cancer network in the Netherlands, including seven hospitals, a project was initiated with the goal of empowering patients and healthcare professionals in SDM throughout primary, secondary and tertiary healthcare settings. A total of 17 participants were assessed. Directed qualitative content analysis was performed by two researchers.

Results: Main findings revealed barriers such as time constraints, lack of priority of physicians, little involvement of general practitioners, and insufficient social context of patients in referrals, alongside facilitators including learning communities with practical SDM examples, metro mapping, involvement of case manager in implementation and patient empowerment strategies.

Conclusion: Addressing cultural, systemic barriers and developing innovative strategies are of importance to enhance SDM in pancreatic cancer treatment in a network approach. This study provides understanding of SDM implementation in complex healthcare settings and offers valuable guidance for future interventions seeking to improve decision-making processes in pancreatic cancer treatment and beyond.

Keywords: Comprehensive Cancer Network; Healthcare Professional Training; Pancreatic Cancer Treatment; Patient Empowerment; Shared decision making (SDM).

FIGURE 1

Metro map for pancreatic cancer trajectory. Colors indicate different phases in the patient journey. Due to the elaborated metro map the image has been cut in multiple sections for readability. Colors, from left to right, indicate the following; orange involves diagnostics by the general practitioner, dark green involves diagnostics in the general hospital by the gastro‐enterologist, blue involves diagnostics in the expert center, light green involves neoadjuvant chemotherapy, purple involves the surgical treatment, light green involves adjuvant chemotherapy, gray involves follow‐up by the surgeon or the medical oncologist.